MANDIBULAR FRACTURES

Contents.
Introduction.
Surgical anatomy
History.
Epidemiology.
Classification systems
Clinical features and diagnosis
Radiographic features
Conclusion.
References.
Introduction.
Maxillofacial injuries.

Mandibular fractures
prominence of mandible

Occlusion

Management.
Surgical anatomy
Strongest facial bone

Parabola shaped bone

Angle of curvature is 110-140

Mandible is the 2nd bone to ossify

Energy of 44.6-74.4 kg/m required to fracture the

mandible.
Weak areas of mandible
Junction between alveolar bone & basal mandibular
bone.

Symphysis region - junction of two individual bones.

Parasymphyseal region - lateral to the mental

prominence, incisive fossa and mental foramen.

Junction of the ramus and the body are fractured

commonly.

Presence of impacted tooth, canine with long roots.

Age changes of mandible.
Mental foramena.
child near inferior border.
old age near alveolar ridge.

Ramus angle.
child & old obtuse

Alveolar ridge

Blood supply
Safe distance in mandible.
Average thickness of
Cortex in symphysis &
parasymphisis
region is 2.5 mm

Average thickness of
Cortex in premolar &
Body region is 3.5 mm
Distance between I.A.
Canal & cortex
At bicuspid - 4.0 mm
Molar region - 5.9 mm

Anteriorly distance
Between adjacent
Root apices is 3.7 mm

Posteriorly distance
Between adjacent
Root apices is 6.3 mm
Champys principles
Forces of mastication produce
tensional forces on upper border &
forces of compression on lower
border.

Champy put forward the lines

where plates & screws have to be
placed - ideal osteosynthesis
lines

It corresponds to course of a line of

tension at base of the alveolar
process.

Only in symphysis region, 2 plates

Blood supply.
Helps in the healing of
fractured bone.

Endosteal blood supply via

inferior dental artery & veins.

Peripheral blood supply -

Periosteum
 Nerve supply.
Inferior alveolar nerve

Damage - angle & body #

Anesthesia or parasthesia of
the nerve

Recovery / regeneration - 3 to
12 months
History.
Egyptian Papyrus (1650 BC)
Examination, diagnosis &
treatment.

Hippocrates Approximation of #
segments.

Salerno, Italy (1180) Proper

occlusion.

1492, the book Cyrurgia by

Guglielmo Salicetti use of IMF.

John Barton - Barton Bandage

1860 GILMER GILMERS WIRING & FULL ARCH BARS

1900 MAHE PLATING KIT SIMILAR TO MODERN

SYSTEMS

1920 F. RISDON RISDONS WIRING

1961 LUHR DYNAMIC COMPRESSION PLATES

1970 BRONS & BOERING LAG SCREWS

1973 MICHELET MINIPLATES FOR MAND

OSTEOSYNTHESIS

1978 CHAMPY MINIPLATE OSTEOSYNTHESIS

PRINCIPALS
Epidemiology.
Etiology:
 Age.
Sex
Site
 CAR ACCIDENTS

ASSAULTS
BIKE ACCIDENTS
Classification
General
Anatomical
Completeness
Mechanism of injury
Number of fragments
Shape of fracture
Direction & favorability of treatment
Presence or absence of teeth
AO classification.
Kruger's Classification
SIMPLE ( CLOSED) Linear fracture lines which do not communicate
with the exterior

COMPOUND The fracture is communicating intraorally or

( OPEN) extraorally.

COMMUNITED Shattering of bone into multiple pieces

 COMPLEX They is adjunct injury to the adjacent nerves or
COMPLICATED major blood vessels , joints.

IMPACTED One fragment is firmly driven within the other fragment and
clinical movement not appreciated

GREENSTICK Only one cortex broken. Common in children

PATHOLOGICAL Spontaneous fracture as a result of normal muscle contraction or

trauma due to increased weakness of underlying bone .

Impacted fracture
Dingman & Natvig classification
Symphysis fracture
Canine region
fracture
Body of the mandible
fracture
Angle fracture
Ramus fracture
Coronoid fracture
Condylar fracture
Dentoalveolar fracture
Direction & favorability of treatment
Horizontally Favourable
Fracture line runs
downward & forward so
upward displacement
avoided

Horizontally
Unfavourable
Fracture line runs Down
Wards and Back Wards
so
upward Displacement
Unrestricted
 VERTICALLY FAVORABLE VERTICALLY UNFAVORABLE

FRACTURE LINE RUNS FROM THE FRACTURE LINE RUNS FROM THE
OUTER BUCCAL PLATE OBLIQUELY INNER LINGUAL PLATE OBLIQUELY
BACKWARDS AND LINGUALLY , MEDIAL BACKWARDS AND BUCCALLY , MEDIAL
MOVEMENT RESTRICTED MOVEMENT UNRESTRICTED
Presence or absence of teeth
Kazanjian V.H. & Converse J.M.

CLASS 1 TEETH ON BOTH MONOMAXILLARY

SIDES OF FRACTURE LINE

CLASS II TEETH ONLY ON ONE SIDE INTERMAXILLARY

OF THE FRACTURE LINE FIXATION

CLASS III EDENTULOUS PATIENT OPEN REDUCTION

/ PROSTHESIS
AO Classification

F NO. OF FRACTURE OR FRAGMENTS

L LOCATION OF THE FRACTURE

O STATUS OF OCCLUSION

S SOFT TISSUE INVOLVEMENT

A ASSOCIATED FRACTURES
F: NO. OF FRACTURES

F0 Incomplete fractures

F1 Single fractures

F2 Multiple fractures

F3 Comminuted fractures

F4 Fracture with bone defect

L: Location of fracture
L1 Pre-canine
L2 Canine
L3 Post-canine
L4 Angle
L5 Supra-angular
L6 Condyle
L7 Coronoid
L8 Alveolar process
O: Status of occlusion

O0 No malocclusion

O1 Malocclusion

O2 Edentulous mandible
A: Associated fracture
A0 None
A1 Dentoalveolar fracture
A2 Nasal bone fracture
A3 Zygoma fracture
A4 Lefort I
A5 Lefort II
A6 Lefort III
Clinical examination.
History
Mechanism of injury
Extraoral / Intraoral
Clinical features.
Extensive edema

Tenderness.

step deformity

bone crepitus

Facial asymmetry
Deviation of jaw Restriction of mouth
opening
Extensive soft tissue and bony defect
 Collapsed arch and Open bite due bilateral poster
Interfragmentary mobility Gagging of occlusion

Open bite and cross bite due to Occlusal step with

Unilateral gagging of occlusion Unilateral cross bite
 Mandibular fracture has to be differentiated from extensive
Soft tissue injury and dentoalveolar trauma

UNILATERAL CROSS BITE UNILATERAL OPEN BITE

 Multiple fragmentation Unfavorable fracture line
With complete loss of occlusion Causing displacement

Sublingual
Displacement of fracture

Direction and intensity of the traumatic force.

Site of fracture.

Direction of fracture line.

Muscle pull exerted on fractured fragments.

Presence or absence of teeth.

Extent of soft tissue wound.

Radiographic features
OPG
PA View
PNS View
Lateral oblique Radiograph
Occlusal view
CT scan.
OPG view

- Commonly used.
- Entire mandible is visualized.
PA view.

Medial / lateral
displacement.
PNS view

Indicated for
Visualizing Medial
Displacement
Of Condylar Neck

The 4th & 5th

MacGregor Line
coincides with Mandible
Occlusal view

Because of distortion in
Symphysis Region in
an OPG , an Occlusal
View is indicated in
Symphysial fractures

Also shows Vertical

Favorability of Body
Fractures
CT scan.

Condylar fracture.

Cervical spine injury.

Management of mandibular fractures.

To be continued..
References.
Oral & maxillofacial trauma- Fonseca,vol 1

Maxillofacial Injuries- Rowe & Williams

Textbook of oral & maxillofacial surgery by Peter Ward

Booth.

Textbook of oral & maxillofacial surgery by Neelima

malik.
Killeys - fractures of the mandible